Heart-Ankle Pulse Wave Velocity Is Superior to Brachial-Ankle Pulse Wave Velocity in Detecting Aldosterone-Induced Arterial Stiffness.

Zheng-Wei Chen,Chin-Chen Chang,Wei-Chieh Huang,Che-Wei Liao,Yu-Wei Chiu,Vin-Cent Wu,Chi-Sheng Hung,Chien-Ting Pan,Yu-Li Lin,Bo-Ching Lee,Yen-Hung Lin,Yi-Yao Chang,Cheng-Hsuan Tsai

doi:10.3390/biomedicines9101285

Abstract

Primary aldosteronism (PA) is associated with higher arterial stiffness compared to essential hypertension (EH). However, few studies have compared different pulse wave velocity (PWV) parameters to detect aldosterone-induced arterial stiffness. In this study, we aimed to compare the sensitivity in detecting aldosterone-induced arterial stiffness between brachial-ankle PWV (baPWV) and heart-ankle PWV (haPWV). We prospectively enrolled 1006 PA patients and 983 EH patients. Detailed medical history, basic biochemistry data and two PWV measurements (baPWV and haPWV) were collected in both groups. We performed analysis on the original cohort and two propensity score matching (PSM) models (model 1 adjusted for age and sex; model 2 adjusted for age, sex, systolic and diastolic blood pressure). The DeLong test was used to compare areas under receiver operating characteristic curves (AUCs) between baPWV and haPWV to predict PA. In all models, the PA patients had significantly higher baPWV compared to the EH patients. The AUC of haPWV was greater than that of baPWV. In conclusion, haPWV seems to be a better PWV parameter than baPWV in detecting aldosterone-induced arterial stiffness.

Highlights

Primary aldosteronism (PA) is the most common endocrine-related secondary hypertension [1,2], accounting for 5–15% of all hypertensive patients, and the rate is even higher in patients with resistant hypertension [3,4]
Pulse wave velocity (PWV) is calculated as the distance between two different points along the arterial tree divided by the pulse wave propagation time [18]
Before propensity score matching (PSM), a total of 1006 PA patients and 983 essential hypertension (EH) patients were enrolled for analysis

Summary

Introduction

Primary aldosteronism (PA) is the most common endocrine-related secondary hypertension [1,2], accounting for 5–15% of all hypertensive patients, and the rate is even higher in patients with resistant hypertension [3,4]. The excess aldosterone in PA causes both cardiovascular structural and functional deterioration [5,6,7,8] and increased cardiovascular and Biomedicines 2021, 9, 1285. The overproduction of aldosterone leads to vascular endothelial dysfunction, which further causes vascular inflammation, vascular remodeling and increased arterial wall stiffness [16]. Pulse wave velocity (PWV) is a widely used non-invasive tool to evaluate arterial wall stiffness [17]. PWV is calculated as the distance between two different points along the arterial tree divided by the pulse wave propagation time [18]. A higher PWV value indicates increased arterial stiffness, which in turn indicates an increased cardiovascular risk [19]

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